Different Choices of Surgical Methods for Duodenal Gastrointestinal Stromal Tumors

Zhuang Chun, Mohd Firdaus Che Ani, Abdullah Almayouf, Jee-sun Kim, Seong-Ho Kong, Do-Joong Park, Han-Kwang Yang, Hyuk-Joon Lee

J Surg Innov Educ. 2025;2(1):22-23.   Published online June 16, 2025

DOI: https://doi.org/10.69474/jsie.2024.00150

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Abstract PDF

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although GISTs can occur anywhere along the GI tract, they are most frequently found in the stomach and small intestine. Duodenal GISTs are rare but clinically significant due to their symptomatology and potential for malignant transformation. Surgical resection remains the cornerstone of curative treatment. Laparoscopic surgery is now the main method for duodenal GIST due to its advantages, including a faster recovery, less pain, and shorter hospital stay. In this video, we demonstrate how we make different choices regarding the surgical methods for duodenal GIST during operation. The technical points are as follows: (1) preliminary judgment of the tumor location according to the preoperative computed tomography scan and gastroscopy findings, (2) fine dissection of the soft tissue and vessels around the duodenum, (3) intraoperative gastroscopy to confirm the tumor location, (4) the final decision regarding the surgical method according to the tumor location and size, (5) confirmation of luminal patency and hemostasis by intraoperative endoscopy.

Laparoscopic Extended Totally Extraperitoneal Hernia Repair with Posterior Component Separation with Transversus Abdominis Release for a Recurrent Incisional Hernia

Sa-Hong Kim, Kyoyoung Park, Chungyoon Kim, Jeesun Kim, Do-Joong Park, Hyuk-Joon Lee, Seong-Ho Kong

J Surg Innov Educ. 2025;2(1):5-8.   Published online June 17, 2025

DOI: https://doi.org/10.69474/jsie.2025.00024

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A patient with multiple comorbidities, including hypertension, type 2 diabetes, hyperlipidemia, and edema, and a prior history of abdominal surgery presented to the gastrointestinal department with a recurrent incisional hernia larger than 10 cm. The patient underwent laparoscopic extended totally extraperitoneal (e-TEP) hernia repair under general anesthesia. The bilateral retrorectal spaces were accessed via three trocars, followed by midline crossover in the upper abdomen and caudal dissection along the fascial defect. Due to the large size of the defect and the anticipated tension, posterior component separation (PCS) with transversus abdominis release (TAR) was performed, with careful preservation of the neurovascular bundles running anterior to the head of the transversus abdominis muscle. After separate closure of the posterior and anterior layers using barbed sutures, a mesh was placed in the intercomponent space to avoid direct contact with intraperitoneal structures. Closed-suction drains were placed bilaterally to prevent seroma formation. The procedure was completed successfully, and the patient experienced no complications. The patient was discharged without complications. A follow-up computed tomography scan demonstrated the integrity of the hernia repair, with progressive resolution of fat infiltration and fluid collection. Laparoscopic e-TEP hernia repair with PCS and TAR provides a safe and effective approach for managing complex recurrent incisional hernias. This technique enables tension-free closure with mesh placement while minimizing intra-abdominal complications.

Gastrointestinal

Laparoscopic Pylorus Preserving Gastrectomy with Intra-Corporeal Gastro-Gastrostomy Guided by Intra-Operative Gastroscopy

Mohd Firdaus Che Ani, Zhuang Chun, Abdullah Almayouf, Jee-sun Kim, Seong-Ho Kong, Do-Joong Park, Han-Kwang Yang, Hyuk-Joon Lee

J Surg Innov Educ. 2024;1(1):28-29.   Published online June 25, 2024

DOI: https://doi.org/10.69474/jsie.2024.00059

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Abstract PDF

Gastric cancer detection is advancing to a point where screening programs can detect gastric cancer at early stages. This allows surgical procedures to be less radical than before. Studies have proven that pylorus preserving gastrectomy is a safe procedure in early T1a and T1b gastric cancers where the tumour location is in the middle third of the stomach. However, due to the small tumour size, determining an appropriate resection margin can be challenging. A few techniques have been developed to overcome this difficulty, and at our centre, we perform intra-operative gastroscopy to synchronize with the laparoscopic view and precisely determine the tumour location for optimal gastric resections. This allows the gastrectomy to be performed safely and prevents inadequate resection leaving tumour cells behind. This video is aimed at sharing our experience in performing pylorus-preserving gastrectomy.

Gastrointestinal

Laparoscopic Conversion Surgery After Three Years of Palliative Chemotherapy for Unresectable Advanced Gastric Cancer

Ma. Jeanesse C. Bernardo, Mohd Firdaus Che Ani, Zhuang Chun, Abdullah Almayouf, Jee-sun Kim, Tae-Yong Kim, Seong-Ho Kong, Do-Joong Park, Han-Kwang Yang, Hyuk-Joon Lee

J Surg Innov Educ. 2024;1(1):26-27.   Published online June 25, 2024

DOI: https://doi.org/10.69474/jsie.2024.00073

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Abstract PDF

Unresectable advanced gastric cancer remains a challenge in treatment, often requiring a multidisciplinary approach. Numerous studies have emphasized the role of palliative chemotherapy as the mainstay treatment for unresectable advanced gastric cancers. Some patients may still require conversion surgery to achieve survival gain and palliation. Several recent papers have shown the safety of laparoscopic gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer. However, there is a difference between neoadjuvant chemotherapy and palliative chemotherapy in terms of the duration of chemotherapy (about 3 months vs. more than 6 months) and the initial state of advanced gastric cancer (resectable vs. unresectable and/or metastatic). To date, the safety and efficacy of laparoscopic gastrectomy after long-term palliative chemotherapy has been rarely reported. This video aims to share our experience in performing laparoscopic distal gastrectomy with D2 lymph node dissection after 3 years of palliative chemotherapy for an unresectable advanced gastric cancer.